|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
20610
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.46
|
| Rate for Payer: Aetna of WY Medicare |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$215.65
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.19
|
| Rate for Payer: Cigna of WY Commercial |
$222.46
|
| Rate for Payer: First Choice Health Commercial |
$204.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$215.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.42
|
| Rate for Payer: HealthUtah PPO |
$227.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.19
|
| Rate for Payer: Multiplan Medicare/VA |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$222.46
|
| Rate for Payer: PacificSource Commercial |
$204.30
|
| Rate for Payer: PHCS PPO |
$215.65
|
| Rate for Payer: Three Rivers PPO |
$170.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.42
|
| Rate for Payer: United Healthcare Commercial |
$197.49
|
| Rate for Payer: United Healthcare Medicare |
$43.42
|
| Rate for Payer: WINHealth Partners Commercial |
$192.95
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
20611
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$56.35
|
| Rate for Payer: Beech Street Commercial |
$437.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: First Choice Health Commercial |
$414.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.35
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$47.90
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$437.00
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.35
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$56.35
|
| Rate for Payer: WINHealth Partners Commercial |
$391.00
|
|
|
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 20600 50
|
| Hospital Charge Code |
20600
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$348.88
|
| Rate for Payer: Aetna of WY Medicare |
$34.27
|
| Rate for Payer: Beech Street Commercial |
$338.20
|
| Rate for Payer: Cash Price |
$249.20
|
| Rate for Payer: Cash Price |
$249.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$345.32
|
| Rate for Payer: Cigna of WY Commercial |
$348.88
|
| Rate for Payer: First Choice Health Commercial |
$320.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$338.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.27
|
| Rate for Payer: HealthUtah PPO |
$356.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$345.32
|
| Rate for Payer: Multiplan Medicare/VA |
$29.13
|
| Rate for Payer: One Health Plan of WY PPO |
$348.88
|
| Rate for Payer: PacificSource Commercial |
$320.40
|
| Rate for Payer: PHCS PPO |
$338.20
|
| Rate for Payer: Three Rivers PPO |
$267.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.27
|
| Rate for Payer: United Healthcare Commercial |
$309.72
|
| Rate for Payer: United Healthcare Medicare |
$34.27
|
| Rate for Payer: WINHealth Partners Commercial |
$302.60
|
|
|
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
20600
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$34.27
|
| Rate for Payer: Beech Street Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: First Choice Health Commercial |
$160.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.27
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$29.13
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$169.10
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$34.27
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$34.27
|
| Rate for Payer: WINHealth Partners Commercial |
$151.30
|
|
|
ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
20604
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Aetna of WY Medicare |
$43.68
|
| Rate for Payer: Beech Street Commercial |
$361.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.68
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$37.13
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$361.00
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$43.68
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$43.68
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
|
|
ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$4,314.00
|
|
|
Service Code
|
HCPCS 27870 80
|
| Hospital Charge Code |
27870
|
| Min. Negotiated Rate |
$827.48 |
| Max. Negotiated Rate |
$4,314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,227.72
|
| Rate for Payer: Aetna of WY Medicare |
$973.50
|
| Rate for Payer: Beech Street Commercial |
$4,098.30
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,184.58
|
| Rate for Payer: Cigna of WY Commercial |
$4,227.72
|
| Rate for Payer: First Choice Health Commercial |
$3,882.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,098.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$973.50
|
| Rate for Payer: HealthUtah PPO |
$4,314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,184.58
|
| Rate for Payer: Multiplan Medicare/VA |
$827.48
|
| Rate for Payer: One Health Plan of WY PPO |
$4,227.72
|
| Rate for Payer: PacificSource Commercial |
$3,882.60
|
| Rate for Payer: PHCS PPO |
$4,098.30
|
| Rate for Payer: Three Rivers PPO |
$3,235.50
|
| Rate for Payer: TriWest Veterans Administration |
$973.50
|
| Rate for Payer: United Healthcare Commercial |
$3,753.18
|
| Rate for Payer: United Healthcare Medicare |
$973.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,666.90
|
|
|
ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$4,314.00
|
|
|
Service Code
|
HCPCS 27870 AS
|
| Hospital Charge Code |
27870
|
| Min. Negotiated Rate |
$827.48 |
| Max. Negotiated Rate |
$4,314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,227.72
|
| Rate for Payer: Aetna of WY Medicare |
$973.50
|
| Rate for Payer: Beech Street Commercial |
$4,098.30
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,184.58
|
| Rate for Payer: Cigna of WY Commercial |
$4,227.72
|
| Rate for Payer: First Choice Health Commercial |
$3,882.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,098.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$973.50
|
| Rate for Payer: HealthUtah PPO |
$4,314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,184.58
|
| Rate for Payer: Multiplan Medicare/VA |
$827.48
|
| Rate for Payer: One Health Plan of WY PPO |
$4,227.72
|
| Rate for Payer: PacificSource Commercial |
$3,882.60
|
| Rate for Payer: PHCS PPO |
$4,098.30
|
| Rate for Payer: Three Rivers PPO |
$3,235.50
|
| Rate for Payer: TriWest Veterans Administration |
$973.50
|
| Rate for Payer: United Healthcare Commercial |
$3,753.18
|
| Rate for Payer: United Healthcare Medicare |
$973.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,666.90
|
|
|
ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$4,314.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
27870
|
| Min. Negotiated Rate |
$827.48 |
| Max. Negotiated Rate |
$4,314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,227.72
|
| Rate for Payer: Aetna of WY Medicare |
$973.50
|
| Rate for Payer: Beech Street Commercial |
$4,098.30
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,184.58
|
| Rate for Payer: Cigna of WY Commercial |
$4,227.72
|
| Rate for Payer: First Choice Health Commercial |
$3,882.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,098.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$973.50
|
| Rate for Payer: HealthUtah PPO |
$4,314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,184.58
|
| Rate for Payer: Multiplan Medicare/VA |
$827.48
|
| Rate for Payer: One Health Plan of WY PPO |
$4,227.72
|
| Rate for Payer: PacificSource Commercial |
$3,882.60
|
| Rate for Payer: PHCS PPO |
$4,098.30
|
| Rate for Payer: Three Rivers PPO |
$3,235.50
|
| Rate for Payer: TriWest Veterans Administration |
$973.50
|
| Rate for Payer: United Healthcare Commercial |
$3,753.18
|
| Rate for Payer: United Healthcare Medicare |
$973.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,666.90
|
|
|
ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 22634
|
| Hospital Charge Code |
22634
|
| Min. Negotiated Rate |
$384.55 |
| Max. Negotiated Rate |
$1,615.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,582.70
|
| Rate for Payer: Aetna of WY Medicare |
$452.41
|
| Rate for Payer: Beech Street Commercial |
$1,534.25
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,566.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,582.70
|
| Rate for Payer: First Choice Health Commercial |
$1,453.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,534.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$452.41
|
| Rate for Payer: HealthUtah PPO |
$1,615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,566.55
|
| Rate for Payer: Multiplan Medicare/VA |
$384.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,582.70
|
| Rate for Payer: PacificSource Commercial |
$1,453.50
|
| Rate for Payer: PHCS PPO |
$1,534.25
|
| Rate for Payer: Three Rivers PPO |
$1,211.25
|
| Rate for Payer: TriWest Veterans Administration |
$452.41
|
| Rate for Payer: United Healthcare Commercial |
$1,405.05
|
| Rate for Payer: United Healthcare Medicare |
$452.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,372.75
|
|
|
ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 22634 AS
|
| Hospital Charge Code |
22634
|
| Min. Negotiated Rate |
$384.55 |
| Max. Negotiated Rate |
$1,615.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,582.70
|
| Rate for Payer: Aetna of WY Medicare |
$452.41
|
| Rate for Payer: Beech Street Commercial |
$1,534.25
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,566.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,582.70
|
| Rate for Payer: First Choice Health Commercial |
$1,453.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,534.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$452.41
|
| Rate for Payer: HealthUtah PPO |
$1,615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,566.55
|
| Rate for Payer: Multiplan Medicare/VA |
$384.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,582.70
|
| Rate for Payer: PacificSource Commercial |
$1,453.50
|
| Rate for Payer: PHCS PPO |
$1,534.25
|
| Rate for Payer: Three Rivers PPO |
$1,211.25
|
| Rate for Payer: TriWest Veterans Administration |
$452.41
|
| Rate for Payer: United Healthcare Commercial |
$1,405.05
|
| Rate for Payer: United Healthcare Medicare |
$452.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,372.75
|
|
|
ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$6,132.00
|
|
|
Service Code
|
HCPCS 22633 AS
|
| Hospital Charge Code |
22633
|
| Min. Negotiated Rate |
$1,460.78 |
| Max. Negotiated Rate |
$6,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,009.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,718.56
|
| Rate for Payer: Beech Street Commercial |
$5,825.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,948.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,009.36
|
| Rate for Payer: First Choice Health Commercial |
$5,518.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,825.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,718.56
|
| Rate for Payer: HealthUtah PPO |
$6,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,948.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1,460.78
|
| Rate for Payer: One Health Plan of WY PPO |
$6,009.36
|
| Rate for Payer: PacificSource Commercial |
$5,518.80
|
| Rate for Payer: PHCS PPO |
$5,825.40
|
| Rate for Payer: Three Rivers PPO |
$4,599.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,718.56
|
| Rate for Payer: United Healthcare Commercial |
$5,334.84
|
| Rate for Payer: United Healthcare Medicare |
$1,718.56
|
| Rate for Payer: WINHealth Partners Commercial |
$5,212.20
|
|
|
ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$6,132.00
|
|
|
Service Code
|
HCPCS 22633 80
|
| Hospital Charge Code |
22633
|
| Min. Negotiated Rate |
$1,460.78 |
| Max. Negotiated Rate |
$6,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,009.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,718.56
|
| Rate for Payer: Beech Street Commercial |
$5,825.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,948.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,009.36
|
| Rate for Payer: First Choice Health Commercial |
$5,518.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,825.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,718.56
|
| Rate for Payer: HealthUtah PPO |
$6,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,948.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1,460.78
|
| Rate for Payer: One Health Plan of WY PPO |
$6,009.36
|
| Rate for Payer: PacificSource Commercial |
$5,518.80
|
| Rate for Payer: PHCS PPO |
$5,825.40
|
| Rate for Payer: Three Rivers PPO |
$4,599.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,718.56
|
| Rate for Payer: United Healthcare Commercial |
$5,334.84
|
| Rate for Payer: United Healthcare Medicare |
$1,718.56
|
| Rate for Payer: WINHealth Partners Commercial |
$5,212.20
|
|
|
ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$6,132.00
|
|
|
Service Code
|
HCPCS 22633
|
| Hospital Charge Code |
22633
|
| Min. Negotiated Rate |
$1,460.78 |
| Max. Negotiated Rate |
$6,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,009.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,718.56
|
| Rate for Payer: Beech Street Commercial |
$5,825.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,948.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,009.36
|
| Rate for Payer: First Choice Health Commercial |
$5,518.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,825.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,718.56
|
| Rate for Payer: HealthUtah PPO |
$6,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,948.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1,460.78
|
| Rate for Payer: One Health Plan of WY PPO |
$6,009.36
|
| Rate for Payer: PacificSource Commercial |
$5,518.80
|
| Rate for Payer: PHCS PPO |
$5,825.40
|
| Rate for Payer: Three Rivers PPO |
$4,599.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,718.56
|
| Rate for Payer: United Healthcare Commercial |
$5,334.84
|
| Rate for Payer: United Healthcare Medicare |
$1,718.56
|
| Rate for Payer: WINHealth Partners Commercial |
$5,212.20
|
|
|
ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
28755
|
| Min. Negotiated Rate |
$278.36 |
| Max. Negotiated Rate |
$1,722.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,687.56
|
| Rate for Payer: Aetna of WY Medicare |
$327.48
|
| Rate for Payer: Beech Street Commercial |
$1,635.90
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,670.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,687.56
|
| Rate for Payer: First Choice Health Commercial |
$1,549.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,635.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.48
|
| Rate for Payer: HealthUtah PPO |
$1,722.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,670.34
|
| Rate for Payer: Multiplan Medicare/VA |
$278.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,687.56
|
| Rate for Payer: PacificSource Commercial |
$1,549.80
|
| Rate for Payer: PHCS PPO |
$1,635.90
|
| Rate for Payer: Three Rivers PPO |
$1,291.50
|
| Rate for Payer: TriWest Veterans Administration |
$327.48
|
| Rate for Payer: United Healthcare Commercial |
$1,498.14
|
| Rate for Payer: United Healthcare Medicare |
$327.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,463.70
|
|
|
ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$3,015.00
|
|
|
Service Code
|
HCPCS 28750 AS
|
| Hospital Charge Code |
28750
|
| Min. Negotiated Rate |
$476.70 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,954.70
|
| Rate for Payer: Aetna of WY Medicare |
$560.82
|
| Rate for Payer: Beech Street Commercial |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,924.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,954.70
|
| Rate for Payer: First Choice Health Commercial |
$2,713.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$560.82
|
| Rate for Payer: HealthUtah PPO |
$3,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,924.55
|
| Rate for Payer: Multiplan Medicare/VA |
$476.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,954.70
|
| Rate for Payer: PacificSource Commercial |
$2,713.50
|
| Rate for Payer: PHCS PPO |
$2,864.25
|
| Rate for Payer: Three Rivers PPO |
$2,261.25
|
| Rate for Payer: TriWest Veterans Administration |
$560.82
|
| Rate for Payer: United Healthcare Commercial |
$2,623.05
|
| Rate for Payer: United Healthcare Medicare |
$560.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,562.75
|
|
|
ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$3,015.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
28750
|
| Min. Negotiated Rate |
$476.70 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,954.70
|
| Rate for Payer: Aetna of WY Medicare |
$560.82
|
| Rate for Payer: Beech Street Commercial |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,924.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,954.70
|
| Rate for Payer: First Choice Health Commercial |
$2,713.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$560.82
|
| Rate for Payer: HealthUtah PPO |
$3,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,924.55
|
| Rate for Payer: Multiplan Medicare/VA |
$476.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,954.70
|
| Rate for Payer: PacificSource Commercial |
$2,713.50
|
| Rate for Payer: PHCS PPO |
$2,864.25
|
| Rate for Payer: Three Rivers PPO |
$2,261.25
|
| Rate for Payer: TriWest Veterans Administration |
$560.82
|
| Rate for Payer: United Healthcare Commercial |
$2,623.05
|
| Rate for Payer: United Healthcare Medicare |
$560.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,562.75
|
|
|
ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$3,015.00
|
|
|
Service Code
|
HCPCS 28750 80
|
| Hospital Charge Code |
28750
|
| Min. Negotiated Rate |
$476.70 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,954.70
|
| Rate for Payer: Aetna of WY Medicare |
$560.82
|
| Rate for Payer: Beech Street Commercial |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,924.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,954.70
|
| Rate for Payer: First Choice Health Commercial |
$2,713.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$560.82
|
| Rate for Payer: HealthUtah PPO |
$3,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,924.55
|
| Rate for Payer: Multiplan Medicare/VA |
$476.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,954.70
|
| Rate for Payer: PacificSource Commercial |
$2,713.50
|
| Rate for Payer: PHCS PPO |
$2,864.25
|
| Rate for Payer: Three Rivers PPO |
$2,261.25
|
| Rate for Payer: TriWest Veterans Administration |
$560.82
|
| Rate for Payer: United Healthcare Commercial |
$2,623.05
|
| Rate for Payer: United Healthcare Medicare |
$560.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,562.75
|
|
|
ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
HCPCS 26860 AS
|
| Hospital Charge Code |
26860
|
| Min. Negotiated Rate |
$512.88 |
| Max. Negotiated Rate |
$2,153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,109.94
|
| Rate for Payer: Aetna of WY Medicare |
$603.39
|
| Rate for Payer: Beech Street Commercial |
$2,045.35
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,088.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,109.94
|
| Rate for Payer: First Choice Health Commercial |
$1,937.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,045.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.39
|
| Rate for Payer: HealthUtah PPO |
$2,153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,088.41
|
| Rate for Payer: Multiplan Medicare/VA |
$512.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,109.94
|
| Rate for Payer: PacificSource Commercial |
$1,937.70
|
| Rate for Payer: PHCS PPO |
$2,045.35
|
| Rate for Payer: Three Rivers PPO |
$1,614.75
|
| Rate for Payer: TriWest Veterans Administration |
$603.39
|
| Rate for Payer: United Healthcare Commercial |
$1,873.11
|
| Rate for Payer: United Healthcare Medicare |
$603.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,830.05
|
|
|
ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
HCPCS 26860
|
| Hospital Charge Code |
26860
|
| Min. Negotiated Rate |
$512.88 |
| Max. Negotiated Rate |
$2,153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,109.94
|
| Rate for Payer: Aetna of WY Medicare |
$603.39
|
| Rate for Payer: Beech Street Commercial |
$2,045.35
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,088.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,109.94
|
| Rate for Payer: First Choice Health Commercial |
$1,937.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,045.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.39
|
| Rate for Payer: HealthUtah PPO |
$2,153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,088.41
|
| Rate for Payer: Multiplan Medicare/VA |
$512.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,109.94
|
| Rate for Payer: PacificSource Commercial |
$1,937.70
|
| Rate for Payer: PHCS PPO |
$2,045.35
|
| Rate for Payer: Three Rivers PPO |
$1,614.75
|
| Rate for Payer: TriWest Veterans Administration |
$603.39
|
| Rate for Payer: United Healthcare Commercial |
$1,873.11
|
| Rate for Payer: United Healthcare Medicare |
$603.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,830.05
|
|
|
ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT
|
Professional
|
Both
|
$4,170.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
26861
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,086.60
|
| Rate for Payer: Aetna of WY Medicare |
$96.39
|
| Rate for Payer: Beech Street Commercial |
$3,961.50
|
| Rate for Payer: Cash Price |
$2,919.00
|
| Rate for Payer: Cash Price |
$2,919.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,044.90
|
| Rate for Payer: Cigna of WY Commercial |
$4,086.60
|
| Rate for Payer: First Choice Health Commercial |
$3,753.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,961.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.39
|
| Rate for Payer: HealthUtah PPO |
$4,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,044.90
|
| Rate for Payer: Multiplan Medicare/VA |
$81.93
|
| Rate for Payer: One Health Plan of WY PPO |
$4,086.60
|
| Rate for Payer: PacificSource Commercial |
$3,753.00
|
| Rate for Payer: PHCS PPO |
$3,961.50
|
| Rate for Payer: Three Rivers PPO |
$3,127.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.39
|
| Rate for Payer: United Healthcare Commercial |
$3,627.90
|
| Rate for Payer: United Healthcare Medicare |
$96.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,544.50
|
|
|
ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,569.00
|
|
|
Service Code
|
HCPCS 26850 AS
|
| Hospital Charge Code |
26850
|
| Min. Negotiated Rate |
$612.04 |
| Max. Negotiated Rate |
$2,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,517.62
|
| Rate for Payer: Aetna of WY Medicare |
$720.05
|
| Rate for Payer: Beech Street Commercial |
$2,440.55
|
| Rate for Payer: Cash Price |
$1,798.30
|
| Rate for Payer: Cash Price |
$1,798.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,491.93
|
| Rate for Payer: Cigna of WY Commercial |
$2,517.62
|
| Rate for Payer: First Choice Health Commercial |
$2,312.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,440.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$720.05
|
| Rate for Payer: HealthUtah PPO |
$2,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,491.93
|
| Rate for Payer: Multiplan Medicare/VA |
$612.04
|
| Rate for Payer: One Health Plan of WY PPO |
$2,517.62
|
| Rate for Payer: PacificSource Commercial |
$2,312.10
|
| Rate for Payer: PHCS PPO |
$2,440.55
|
| Rate for Payer: Three Rivers PPO |
$1,926.75
|
| Rate for Payer: TriWest Veterans Administration |
$720.05
|
| Rate for Payer: United Healthcare Commercial |
$2,235.03
|
| Rate for Payer: United Healthcare Medicare |
$720.05
|
| Rate for Payer: WINHealth Partners Commercial |
$2,183.65
|
|
|
ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,569.00
|
|
|
Service Code
|
HCPCS 26850
|
| Hospital Charge Code |
26850
|
| Min. Negotiated Rate |
$612.04 |
| Max. Negotiated Rate |
$2,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,517.62
|
| Rate for Payer: Aetna of WY Medicare |
$720.05
|
| Rate for Payer: Beech Street Commercial |
$2,440.55
|
| Rate for Payer: Cash Price |
$1,798.30
|
| Rate for Payer: Cash Price |
$1,798.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,491.93
|
| Rate for Payer: Cigna of WY Commercial |
$2,517.62
|
| Rate for Payer: First Choice Health Commercial |
$2,312.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,440.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$720.05
|
| Rate for Payer: HealthUtah PPO |
$2,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,491.93
|
| Rate for Payer: Multiplan Medicare/VA |
$612.04
|
| Rate for Payer: One Health Plan of WY PPO |
$2,517.62
|
| Rate for Payer: PacificSource Commercial |
$2,312.10
|
| Rate for Payer: PHCS PPO |
$2,440.55
|
| Rate for Payer: Three Rivers PPO |
$1,926.75
|
| Rate for Payer: TriWest Veterans Administration |
$720.05
|
| Rate for Payer: United Healthcare Commercial |
$2,235.03
|
| Rate for Payer: United Healthcare Medicare |
$720.05
|
| Rate for Payer: WINHealth Partners Commercial |
$2,183.65
|
|
|
ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT
|
Professional
|
Both
|
$2,864.00
|
|
|
Service Code
|
HCPCS 28740 80
|
| Hospital Charge Code |
28740
|
| Min. Negotiated Rate |
$509.86 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,806.72
|
| Rate for Payer: Aetna of WY Medicare |
$599.83
|
| Rate for Payer: Beech Street Commercial |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,778.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,806.72
|
| Rate for Payer: First Choice Health Commercial |
$2,577.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,720.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$599.83
|
| Rate for Payer: HealthUtah PPO |
$2,864.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,778.08
|
| Rate for Payer: Multiplan Medicare/VA |
$509.86
|
| Rate for Payer: One Health Plan of WY PPO |
$2,806.72
|
| Rate for Payer: PacificSource Commercial |
$2,577.60
|
| Rate for Payer: PHCS PPO |
$2,720.80
|
| Rate for Payer: Three Rivers PPO |
$2,148.00
|
| Rate for Payer: TriWest Veterans Administration |
$599.83
|
| Rate for Payer: United Healthcare Commercial |
$2,491.68
|
| Rate for Payer: United Healthcare Medicare |
$599.83
|
| Rate for Payer: WINHealth Partners Commercial |
$2,434.40
|
|
|
ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT
|
Professional
|
Both
|
$2,864.00
|
|
|
Service Code
|
HCPCS 28740
|
| Hospital Charge Code |
28740
|
| Min. Negotiated Rate |
$509.86 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,806.72
|
| Rate for Payer: Aetna of WY Medicare |
$599.83
|
| Rate for Payer: Beech Street Commercial |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,778.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,806.72
|
| Rate for Payer: First Choice Health Commercial |
$2,577.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,720.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$599.83
|
| Rate for Payer: HealthUtah PPO |
$2,864.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,778.08
|
| Rate for Payer: Multiplan Medicare/VA |
$509.86
|
| Rate for Payer: One Health Plan of WY PPO |
$2,806.72
|
| Rate for Payer: PacificSource Commercial |
$2,577.60
|
| Rate for Payer: PHCS PPO |
$2,720.80
|
| Rate for Payer: Three Rivers PPO |
$2,148.00
|
| Rate for Payer: TriWest Veterans Administration |
$599.83
|
| Rate for Payer: United Healthcare Commercial |
$2,491.68
|
| Rate for Payer: United Healthcare Medicare |
$599.83
|
| Rate for Payer: WINHealth Partners Commercial |
$2,434.40
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$1,068.00
|
|
|
Service Code
|
HCPCS 22632
|
| Hospital Charge Code |
22632
|
| Min. Negotiated Rate |
$254.38 |
| Max. Negotiated Rate |
$1,068.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,046.64
|
| Rate for Payer: Aetna of WY Medicare |
$299.27
|
| Rate for Payer: Beech Street Commercial |
$1,014.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,035.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,046.64
|
| Rate for Payer: First Choice Health Commercial |
$961.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,014.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.27
|
| Rate for Payer: HealthUtah PPO |
$1,068.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,035.96
|
| Rate for Payer: Multiplan Medicare/VA |
$254.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,046.64
|
| Rate for Payer: PacificSource Commercial |
$961.20
|
| Rate for Payer: PHCS PPO |
$1,014.60
|
| Rate for Payer: Three Rivers PPO |
$801.00
|
| Rate for Payer: TriWest Veterans Administration |
$299.27
|
| Rate for Payer: United Healthcare Commercial |
$929.16
|
| Rate for Payer: United Healthcare Medicare |
$299.27
|
| Rate for Payer: WINHealth Partners Commercial |
$907.80
|
|
